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Gay, Lesbian, and Bisexual Adolescents

Understanding a child's or adolescent's sexual and emotional development is an essential part of any comprehensive pediatric evaluation. For youth who are or might be gay, lesbian, or bisexual ( GLB ), such understanding is particularly important. GLB youth as a group have the same health and developmental needs as all youth, and their sexual orientation is part of the spectrum of human sexuality. However, they…

Gender and Sexual Identity

Terms and Definitions Sex and Sexual Identity Sex is multifaceted, with at least 9 components: chromosomal sex, gonadal sex, fetal hormonal sex (prenatal hormones produced by the gonads), internal morphologic sex (internal genitalia), external morphologic sex (external genitalia), hypothalamic sex (sex of the brain), sex of assignment and rearing, pubertal hormonal sex, and gender identity and role. Sexual identity is a self-perceived identification distilled from any…

Adolescent Physical and Social Development

See also Part XV and Chapters 577 and 578 . During the preteen, teenage, and young adult years, young people undergo not only dramatic changes in physical appearance, but also rapid changes in physiologic, psychological, and social functioning. Hormonally driven physiologic changes and ongoing neurologic development occur in the setting of social structures that foster the transition from childhood to adulthood. This period of development comprises…

Congenital and Perinatal Infections

Infections are a frequent and important cause of neonatal morbidity and mortality. Congenital or intrauterine infections (i.e., those transmitted across the placenta) and perinatal infections (i.e., those transmitted from the mother to the fetus or newborn infant during the birth process) represent 2 major routes of neonatal infection. Congenital Infections Felicia A. Scaggs Huang Rebecca C. Brady As many as 2% of fetuses are infected in utero; disease…

Healthcare-Acquired Infections

Premature and very-low-birthweight (VLBW) infants often have prolonged hospitalizations and are particularly prone to healthcare-acquired infection ( HAI ) because of their inefficient innate immunity, deficient skin barriers, presence of indwelling catheters and other devices, and prolonged endotracheal intubation ( Table 130.1 ). HAIs are associated with increased length of hospitalization, increased cost of care, and significant morbidity and mortality. Table 130.1 Definitions of Healthcare-Acquired Infections…

Epidemiology of Infections

Infections in the newborn are often classified by their timing relative to birth and include congenital, perinatal, early-onset, and late-onset disease. These are clinically useful designations because the mechanisms of infection, etiologies, and outcomes are distinct at each stage. Congenital infection denotes infection acquired in utero. Such infections are generally caused by viral or other non-bacterial organisms and are often associated with injury to developing organs…

Dysmorphology

Dysmorphology is the study of differences in human form and the mechanisms that cause them. It has been estimated that 1 in 40 newborns, or 2.5%, have a recognizable birth defect or pattern of malformations at birth; approximately half these newborns have a single, isolated malformation, whereas in the other half, multiple malformations are present. From 20–30% of infant deaths and 30–50% of deaths after the…

The Endocrine System

Endocrine emergencies in the newborn period are uncommon, but prompt identification and proper treatment are vital to reduce morbidity and mortality. Pituitary dwarfism (growth hormone deficiency) is not usually apparent at birth, although male infants with panhypopituitarism may have neonatal hypoglycemia, hyperbilirubinemia, and micropenis. Conversely, primordial dwarfism manifests as in utero growth failure that continues postnatally, with length and weight suggestive of prematurity when born after…

Abstinence Syndromes

Neonatal Abstinence (Withdrawal) Scott L. Wexelblatt Keywords benzodiazepine buprenorphine cocaine MAT medication-assisted treatment methadone methamphetamine NAS neonatal abstinence syndrome opioid phenobarbital Neonatal abstinence syndrome (NAS) is the clinical diagnosis given to infants who experience withdrawal signs after in utero exposure to opioids. Withdrawal signs develop in 55–94% of opioid-exposed infants, 30–65% of whom need pharmacologic treatment for severe withdrawal. The incidence of NAS has been increasing yearly…

The Umbilicus

Umbilical Cord The umbilical cord typically consists of 2 umbilical arteries, the umbilical vein, and a gelatinous substance called Wharton's jelly, all contained within a sheath derived from the amnion and coiled into a helical shape. The muscular umbilical arteries carry deoxygenated blood from the fetus to the placenta and are contiguous with the fetal internal iliac arteries. The umbilical vein carries oxygenated blood from the…

Blood Disorders

Anemia in the Newborn Infant Patrick T. McGann Russell E. Ware Keywords ABO incompatibility anemia of prematurity fetomaternal hemorrhage G6PD deficiency hereditary spherocytosis physiologic nadir Anemia is a common laboratory and clinical finding in the newborn period and carries a broad differential diagnosis. Anemia in the newborn may be acute or chronic, and its clinical manifestations range from an asymptomatic laboratory finding to life-threatening signs and symptoms. The…

Digestive System Disorders

Meconium Ileus, Peritonitis, and Intestinal Obstruction Juan P. Gurria Rebeccah L. Brown Keywords anorectal plugs cystic fibrosis Gastrografin enema meconium ileus meconium peritonitis meconium plugs Meconium consists of bile salts, bile acids, and debris shed from the intestinal mucosa in the intrauterine period. More than 90% of full-term newborn infants and 80% of very-low-birthweight (VLBW) infants pass meconium within the 1st 24 hr. The possibility of intestinal obstruction should…

Respiratory Tract Disorders

Respiratory disorders are the most frequent cause of admission for neonatal intensive care in both term and preterm infants. Signs and symptoms of respiratory distress include cyanosis, expiratory grunting, nasal flaring, retractions, tachypnea, decreased breath sounds with or without rales and/or rhonchi, and pallor. A wide variety of pathologic lesions may be responsible for respiratory disturbances, including pulmonary, airway, cardiovascular, central nervous system, infectious, and other…

Neonatal Resuscitation and Delivery Room Emergencies

Most infants complete the transition to extrauterine life without difficulty; however, a small proportion require resuscitation after birth ( Fig. 121.1 ). For a newborn infant, the need for resuscitation is often caused by a problem with respiration leading to inadequate ventilation. This is in contrast to an adult cardiac arrest, which is usually caused by inadequate circulation. The goals of neonatal resuscitation are to reestablish…

Nervous System Disorders

Central nervous system (CNS) disorders are important causes of neonatal mortality and both short-term and long-term morbidity. The CNS can be injured as a result of asphyxia, hemorrhage, trauma, hypoglycemia, or direct cytotoxicity. The etiology of CNS injury is often multifactorial and includes perinatal complications, postnatal hemodynamic instability, and developmental abnormalities that may be genetic and/or environmental. Predisposing factors for brain injury include chronic and acute…

Clinical Manifestations of Diseases in the Newborn Period

A variety of conditions that affect the newborn originate in utero, during birth, or in the immediate postnatal period. These disorders can be caused by prematurity, congenital malformations, disruption of chromosome structure, or acquired diseases and injuries. Recognizing disease in newborn infants requires knowledge of relevant pathophysiology and evaluation of nonspecific clinical signs and symptoms. Abnormal Movements Neonatal seizures usually suggest a central nervous system (CNS)…

Transport of the Critically Ill Newborn

Regionalized Care of Newborns The concept of regionalized care for neonates was first introduced in the 1976 March of Dimes Report Toward Improving the Outcome of Pregnancy. This report and future revisions stress the importance of providing regionalized care for infants in facilities with adequate personnel and equipment for an infant's severity of illness. Ideally, mothers deliver infants at a facility with the appropriate level of…

The High-Risk Infant

The term high-risk infant designates an infant at greater risk for neonatal morbidity and mortality; many factors can contribute to an infant being high risk ( Table 117.1 ). High-risk infants are categorized into 4 main groups: the preterm infant, infants with special health care needs or dependence on technology, infants at risk because of family issues, and infants with anticipated early death. Table 117.1 Factors…

Fetal Intervention and Surgery

Numerous diagnoses have been evaluated for the possibility of fetal intervention ( Tables 116.1 and 116.2 ). Some have proved beneficial to the developing infant, some have been abandoned, and some are still under investigation. Table 116.1 Fetal Diagnoses Evaluated and Treated in Fetal Centers Amniotic band syndrome (ABS) Anomalies in monochorionic twins Aortic stenosis Arachnoid cyst Bladder exstrophy Bladder outlet obstruction Bronchopulmonary sequestration (BPS) Cervical…

The Fetus

The major emphasis in fetal medicine involves (1) assessment of fetal growth and maturity, (2) evaluation of fetal well-being or distress, (3) assessment of the effects of maternal disease on the fetus, (4) evaluation of the effects of drugs administered to the mother on the fetus, and (5) identification and when possible treatment of fetal disease or anomalies. One of the most important tools used to…